Combining dimensional and categorical representation of psychosis: the way forward for DSM-V and ICD-11?

Demjaha, Arsime; Morgan, Kevin; Morgan, Craig; Landau, Sabine; Dean, Kimberlie; Reichenberg, Abraham; Sham, Pak C.; Fearon, Paul; Hutchinson, Gerard; Jones, Peter B.; Murray, Robin M.; Dazzan, Paola

doi:10.1017/s0033291709990651

Cited by 92 publications

(86 citation statements)

References 65 publications

(104 reference statements)

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“…Using factor analysis, baseline symptoms were categorized into five psychopathological dimensions (manic, reality distortion, negative, depressive and disorganized) (Demjaha et al 2009). Age at onset was established as the age at which first psychotic symptoms appeared.…”

Section: Baseline Clinical Assessmentmentioning

confidence: 99%

Antipsychotic treatment resistance in first-episode psychosis: prevalence, subtypes and predictors

et al. 2017

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Background. We examined longitudinally the course and predictors of treatment resistance in a large cohort of firstepisode psychosis (FEP) patients from initiation of antipsychotic treatment. We hypothesized that antipsychotic treatment resistance is: (a) present at illness onset; and (b) differentially associated with clinical and demographic factors.Method. The study sample comprised 323 FEP patients who were studied at first contact and at 10-year follow-up. We collated clinical information on severity of symptoms, antipsychotic medication and treatment adherence during the follow-up period to determine the presence, course and predictors of treatment resistance.Results. From the 23% of the patients, who were treatment resistant, 84% were treatment resistant from illness onset. Multivariable regression analysis revealed that diagnosis of schizophrenia, negative symptoms, younger age at onset, and longer duration of untreated psychosis predicted treatment resistance from illness onset.Conclusions. The striking majority of treatment-resistant patients do not respond to first-line antipsychotic treatment even at time of FEP. Clinicians must be alert to this subgroup of patients and consider clozapine treatment as early as possible during the first presentation of psychosis.

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Section: Baseline Clinical Assessmentmentioning

confidence: 99%

Antipsychotic treatment resistance in first-episode psychosis: prevalence, subtypes and predictors

et al. 2017

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“…The category of schizophrenia-type psychosis, confined to the most severely ill patients with poor outcome, may be beneficial in approximating need for care, outcome, course and treatment (Kendell & Jablensky, 2003). However, mounting evidence suggests that a transdiagnostic dimensional approach, complementary to the clinical utility of the categorical approach, may provide in-depth information that covers different aspects of psychopathology beyond the borders of the modern operationalized criteria (Demjaha et al 2009;Russo et al 2014;van Os & Reininghaus, 2016). One of the clinically-derived arguments for Kraepelinian dichotomy is that patients with bipolar disorder respond to lithium, whereas patients with non-affective psychosis do not.…”

Section: Transdiagnostic Psychosis Manifestationmentioning

confidence: 99%

The slow death of the concept of schizophrenia and the painful birth of the psychosis spectrum

2017

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The concept of schizophrenia only covers the 30% poor outcome fraction of a much broader multidimensional psychotic syndrome, yet paradoxically has become the dominant prism through which everything ‘psychotic’ is observed, even affective states with mild psychosis labelled ‘ultra-high risk’ (for schizophrenia). The inability of psychiatry to frame psychosis as multidimensional syndromal variation of largely unpredictable course and outcome – within and between individuals – hampers research and recovery-oriented practice. ‘Psychosis’ remains firmly associated with ‘schizophrenia’, as evidenced by a vigorous stream of high-impact but non-replicable attempts to ‘reverse-engineer’ the hypothesized biological disease entity, using case–control paradigms that cannot distinguish between risk for illness onset and risk for poor outcome. In this paper, the main issues surrounding the concept of schizophrenia are described. We tentatively conclude that with the advent of broad spectrum phenotypes covering autism and addiction in DSM5, the prospect for introducing a psychosis spectrum disorder – and modernizing psychiatry – appears to be within reach.

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“…Indeed, we have recently proposed exactly this 8 . This does have some empirical support, in that adding symptom factor scores to diagnostic categories has been shown to significantly increase the amount of variability explained in predicting, among other things, duration of untreated psychosis 9 . The reverse approach, of adding categories to continua, as van Os and Reininghaus seem to propose, fared less well.…”

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confidence: 87%

Whether “psychosis” is best conceptualized as a continuum or in categories is an empirical, practical and political question

Lawrie

2016

World Psychiatry

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Combining dimensional and categorical representation of psychosis: the way forward for DSM-V and ICD-11?

Abstract: Categorical and dimensional representations of psychosis are complementary. Using both appears to be a promising strategy in conceptualising psychotic illnesses.

Cited by 92 publications

References 65 publications

Antipsychotic treatment resistance in first-episode psychosis: prevalence, subtypes and predictors

Antipsychotic treatment resistance in first-episode psychosis: prevalence, subtypes and predictors

The slow death of the concept of schizophrenia and the painful birth of the psychosis spectrum

Whether “psychosis” is best conceptualized as a continuum or in categories is an empirical, practical and political question

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